Evidence-Based Physiotherapy for Acute Low Back Pain: A Composite Clinical Algorithm Synthesized from Seven Recent Clinical Guidelines

Abstract

Purpose: To produce a composite evidence-based treatment algorithm for physiotherapy management of acute low back pain (LBP) using current, high-quality, English-language clinical guidelines. Methods: A systematic literature review of library databases and Internet search engines was performed to identify full-text, Englishlanguage clinical guidelines on the physiotherapy treatment of acute LBP. Quality assessment of the guidelines was undertaken by two independent reviewers using the AGREE instrument. Guideline recommendations were synthesized into interventions that were supported by strong, moderate or weak evidence. A composite clinical algorithm for physiotherapy management of acute LBP was developed. Results: Seven guidelines were included. Keeping active, written patient education, manipulation and referral to a spine specialist had strong supporting evidence for the management of acute non-radiating LBP. There were a large number of treatment options with moderate or inconclusive evidence. Bed rest and massage, as stand-alone treatments, had strong evidence of harm for patients with acute non-radiating LBP. Conclusions: Based on current evidence, a composite algorithm was constructed to assist physiotherapists when making treatment decisions for acute LBP. A synthesis of current clinical guideline recommendations provides physiotherapists with readily interpretable guidance for the management of acute LBP and encourages the uptake of best-evidence treatment options.